Acaroglu Emre, Guler Umit Ozgur, Cetinyurek-Yavuz Aysun, Yuksel Selcen, Yavuz Yasemin, Ayhan Selim, Domingo-Sabat Montse, Pellise Ferran, Alanay Ahmet, Perez Grueso Francesco S, Kleinstück Frank, Obeid Ibrahim
Ankara Spine Center, Ankara, Turkey.
Ankara Spine Center, Ankara, Turkey.
Acta Orthop Traumatol Turc. 2017 May;51(3):181-190. doi: 10.1016/j.aott.2017.03.003. Epub 2017 Apr 25.
The aim of this study was to analyze the impact of treatment complications on outcomes in adult spinal deformity (ASD) using a decision analysis (DA) model.
The study included 535 ASD patients (371 with non-surgical (NS) and 164 with surgical (S) treatment) from an international multicentre database of ASD patients. DA was structured in two main steps; 1) Baseline analysis (Assessing the probabilities of outcomes, Assessing the values of preference -utilities-, Combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and 2) Sensitivity analysis. Complications were analyzed as life threatening (LT) and nonlife threatening (NLT) and their probabilities were calculated from the database as well as a thorough literature review. Outcomes were analyzed as improvement, no change and deterioration. Death/complete paralysis was considered as a separate category.
All 535 patients were analyzed in regard to complications. Overall, there were 78 NLT and 12 LT complications and 3 death/paralysis. Surgical treatment offered significantly higher chances of clinical improvement but also was significantly more prone to complications (31.7% vs. 11.1%, p < 0.001).
Surgical treatment of ASD is more likely to cause complications compared to NS treatment. On the other hand, surgery has been shown to provide a higher likelihood of improvement in HRQoL scores. So, the decision on the type of treatment in ASD needs to take both chances of improvement and burden associated with S or NS treatments and better be arrived by the active participation of patients and physicians equipped with the present information.
Level II, Decision analysis.
本研究旨在使用决策分析（DA）模型分析治疗并发症对成人脊柱畸形（ASD）治疗结果的影响。
该研究纳入了来自一个国际多中心ASD患者数据库的535例ASD患者（371例接受非手术（NS）治疗，164例接受手术（S）治疗）。DA主要分为两个步骤；1）基线分析（评估结果的概率、评估偏好效用值、结合概率和效用信息并为每种治疗分配质量调整生命预期（QALE））和2）敏感性分析。将并发症分析为危及生命（LT）和非危及生命（NLT），并根据数据库以及全面的文献综述计算其概率。将结果分析为改善、无变化和恶化。死亡/完全瘫痪被视为一个单独的类别。
对所有535例患者的并发症进行了分析。总体而言，有78例NLT并发症和12例LT并发症以及3例死亡/瘫痪。手术治疗提供了显著更高的临床改善机会，但也明显更容易出现并发症（31.7%对11.1%，p<0.001）。
与NS治疗相比，ASD的手术治疗更有可能导致并发症。另一方面，手术已被证明在提高健康相关生活质量（HRQoL）评分方面具有更高的可能性。因此，ASD治疗类型的决策需要同时考虑改善的机会以及与S或NS治疗相关的负担，并且最好由具备当前信息的患者和医生积极参与来做出。
二级，决策分析。
